Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
BMC Cancer. 2024 Jul 24;24(1):891. doi: 10.1186/s12885-024-12647-2.
After radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer.
Patients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing.
Ninety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group.
Both the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer.
The study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.
根治性膀胱切除术（RC）后，体力活动对于降低并发症风险非常重要，但患有膀胱癌的患者在达到体力活动和运动的一般建议方面存在困难。因此，本随机对照试验的目的是评估初级保健中进行的体育锻炼方案对因膀胱癌接受机器人辅助根治性膀胱切除术（RC）后出院患者的影响。
邀请 2019 年 9 月至 2022 年 10 月在瑞典卡罗林斯卡大学医院接受机器人辅助 RC 的膀胱癌患者参加本研究。出院时，他们被随机分配到干预组或主动对照组。干预组计划在第三周开始由物理治疗师在初级保健中进行运动；该方案包括有氧运动和力量训练，每周两次，共 12 周，每天散步。对照组接受非监督家庭运动，包括每天散步和坐站运动。在手术前、出院时和四个月时评估主要结局（六分钟步行测试）体力功能，以及次要结局体力活动、疼痛、健康相关生活质量、疲劳和心理健康。
90 例患者入选，平均（标准差）年龄 71.5（8.5）岁。意向治疗分析显示，主要结局体力功能或疼痛或心理健康均无干预效果，但体力活动有效果，出院至四个月时干预组和对照组的中位数（IQR）每日步数分别为 4790（3000）和 2670（4340）（p=0.046），疲劳和健康相关生活质量也有利于干预组。
干预组和对照组的体力功能均有所改善，但在初级保健中进行锻炼的患者在体力活动、疲劳和健康相关生活质量方面有额外的积极效果。因此，RC 后出院后在初级保健中进行锻炼可能是膀胱癌患者的一种有前途的方法。
该研究在临床试验中注册，注册号为 NCT03998579，20190607。
